IVF & ICSI Questions

What is in vitro fertilisation?

In vitro fertilisation (IVF) is the process of combining sperm and egg in a laboratory to create embryos. IVF may be used as a treatment for infertility, to create embryos to freeze for later use, or as a way to use frozen eggs when you’re ready to get pregnant.

What is intracytoplasmic sperm injection (ICSI)?

Intracytoplasmic sperm injection, or ICSI, is an IVF technique in which a single sperm is injected directly into the egg. ICSI is commonly used in the case of a male fertility issue that affects the sperm’s ability to naturally penetrate the egg, such as abnormal sperm morphology (size/shape) or motility (movement).

What is the difference between IVF and ICSI?

In-vitro fertilisation, which translates to “in-glass” fertilisation, occurs in much the same way natural conception does. Eggs are mixed with millions of sperm in a carefully controlled vessel, and the sperm flood around the egg until one of them penetrates its protective barrier, locking all the other sperm out. Just as in natural conception, this requires a very high sperm-to-egg ratio, and therefore this option will not help males with moderate to severe infertility to conceive.

Efforts to reduce the sperm-to-egg ratio needed for IVF led to the development of ICSI – in contrast to conventional IVF, ICSI only needs a sperm-to-egg ratio of 1-to-1. The process begins in the same way as conventional IVF; eggs are collected from the woman by hyper-stimulating her ovaries, and a sperm sample is collected through ejaculate or testicular sperm extraction (TESE – a method of sperm extraction directly from the testicles) for more severe cases. However, once these samples have been collected, instead of mixing them together, a single sperm is selected for implantation into the egg. This sperm is drawn up into an extremely thin pipette which is then pushed through the egg’s outer wall, allowing the sperm to be released into the center of the egg, where it should hopefully achieve fertilisation.

By reducing the number of sperm needed to fertilise an egg to just one (although in practicality more than one sperm cell is required, just not millions), a vast number of men who were previously unable to father children – including those due to genetic causes – now have the option to. This represents a huge leap forward for the field of fertility, but it comes at a cost.

When is the ICSI treatment recommended?

ICSI is the treatment of choice if there has been a history of fertilisation failure or very poor sperm quality. ICSI can enable couples to use the partner’s sperm in cases where donor sperm would have been the only option in the past. ICSI is needed whenever sperm is obtained by surgical retrieval, such as after unreversed vasectomy.

The IVF procedure is exactly the same as for conventional IVF as far as the stimulation phase, egg retrieval and subsequent culture after fertilisation . However, the big difference comes when it is time for the insemination procedure.

In most cases, we will have made the decision as to whether the insemination should be carried out with ICSI or conventional IVF well before the day of the egg retrieval. In some cases, we will leave the final

What are the success rates of IVF?

IVF success rates depend on a few factors, including the age of the egg, the age of the sperm, the quality of the lab, how many eggs are retrieved, and the cause of infertility. Generally speaking, success rates for women under 35 are over 40% per cycle; for women 35–40, around 20–30% per cycle; and for women over 40, 15% or less per cycle.

What is the difference between a “fresh” IVF cycle and a “frozen” IVF cycle?

In a “fresh” IVF cycle, an embryo is transferred into the uterus immediately after it’s reached the appropriate level of development (typically after 5–6 days). In a frozen or “freeze all” cycle, the embryos are frozen instead, and may later be thawed to use in an embryo transfer. Frozen cycles follow the same process as embryo freezing (below), but typically an embryo is thawed and transferred with the next menstrual cycle.

Doctors may recommend a frozen cycle to allow additional time for the uterine lining to grow for a higher chance of pregnancy, or pending the results of PGD/PGS testing.

What are the health risks of infertility treatment for women?

The procedure itself is not dangerous but the drugs used to treat infertility can have side effects, and there is general anesthesia involved. Speak with your physician to understand how we mitigate any risks such as ovarian hyperstimulation syndrome (OHSS).

Is IVF safe?

There is a lot of dilemma related to IVF treatment. It is one kind of assisted pregnancy procedure. It can result in multiple pregnancies as more than one embryo is transferred into the women’s uterus. It is done so that the probability of achieving pregnancies increases. But due to elective single embryo transfer it is now possible to reduce number of embryos transferred. We should not see it as a risk anyway. People are blessed with twins even naturally. If double happiness is coming your way you should accept it whole heartedly.

Most women take fertility medicines or hormones to stimulate the ovaries to produce one or more eggs. Having several eggs available for IVF will increase the chances that you will get pregnant. There may be some side effects of these medicines. So check yourself out for any allergies that can be caused due to IVF. Usually, there are no serious complications related to it.

Apart from these, IVF is very safe for anyone. Always go for an experienced doctor to avoid any kinds of complication.

What are the risks of having a baby via IVF?

In the recent times with the advance in technology, In ART-IVF the risks related to IVF are very minimal.

The major risk related to IVF is the development of side effect called OHSS-ovarian hyper stimulation where a greater number of eggs than intended develop and hence women are at risk of fluid collecting in the chest and abdomen and can potentially lead to renal problems such as decreased urine output and tendency for blood clots-thrombosis and can at times be life threatening too. Women with PCOS are more at risk of developing this problem.

However, these days we have safe trigger injections so that we can collect the eggs , make embryos and freeze them so that they can be transferred at a later date when it is safe to be implanted and the risk of OHSS is not present. This is the approach taken by many clinicians to minimise or eliminate the risk of OHSS in PCOS patients.

How do I prepare for a successful IVF treatment?

Preparation for successful treatment of IVF is just as simple as some small changes in your daily routine and diet. Best IVF Clinic in Delhi says that you should make the following preparations from at least 3 months before the procedure starts to improve your IVF results:

  1. Maintaining a well-balanced diet: Start with the preparation of a diet full of proteins that will improve your physical and reproductive health including weight management.
  2. Take prenatal vitamins: You should start taking prenatal vitamins a month before the procedure and certainly after it as they help in the better development of the baby.
  3. No Smoking and Drinking: Smoking has an irreversible effect on reproductive health and drinking, Is also assumed to be harmful, so it is best to avoid them. Also, if you are on any recreational drugs, their consumption is to be avoided too.
  4. Stay Safe: Stay safe here means, avoiding the visit to any places with a spread of infectious diseases that could delay your treatment. Also, any physical activity that could be dangerous for your health is to be avoided.
  5. Eliminate Caffeine: If your caffeine intake is regular and that too in high quantities, It is advised that you reduce your caffeine intake or if possible, try to eliminate it.

What happens during my first IVF appointment?

Please call 91500 91800 and fix your FIRST APPOINTMENT. Please bring your spouse along. After registration at our Reception, our team will guide you to take a complete and detailed history in total privacy, which will usually take 15 minutes. You will then be led to meet the Fertility Specialist who will get to know you, review your medical history and your partner’s history, and usually do a quick physical exam for you at the first visit. She may recommend preliminary diagnostic tests such as Blood tests, Ultrasound scans and Semen Analysis before treating you for infertility (If you have had any previous fertility testing or treatments it is very helpful to provide these records during the first visit so that your PSFC team can review them – this may avoid duplicating tests that don’t need to be redone). She may advise for Fertility Wellness program or Medication as she may deem fit. At this stage, you may take a pause and check if you would like to continue with PSFC. We respect your decision. Your satisfaction or your money back.

At this stage, the doctor does not prescribe for IVF or ICSI unless she is thoroughly satisfied that these are the treatment options. Your doctor will most likely explain the IVF process to you at your follow-up visits.

This is a general overview, but we hope it helps.

When doing IVF is it possible to get pregnant naturally?

It’s unlikely but possible for an egg to fertilise naturally during an IVF Cycle – we remove most of the eggs from the follicles in your ovaries at the time of egg retrieval, but a small number of eggs could remain in or around the ovaries. For this reason, egg donors need to abstain from intercourse during their treatment until advised that it’s safe to resume.

Is IVF ever done without fertility drugs?

Yes, but natural cycle IVF (no fertility drugs) where only one egg is typically obtained or ‘minimal stimulation IVF’ with Clomid or low-dose fertility shots has much lower chances of success compared with ‘conventional IVF’ with higher doses of injectable medications when we are aiming to obtain multiple eggs. Costs are lower and the risk of multiple pregnancies is lower, but the results are worse. More eggs give us a higher chance of having high-quality embryos from which to choose the best ones to transfer back into you.

If you conceive a child via IVF, what traits can you currently select for?

IVF can be combined with Pre-implantation Genetic Diagnosis (PGD) where we test one or more cells from each developing embryo. PGD can be used for most single gene disorders (diseases caused by one gene) such as cystic fibrosis, Huntington’s, Polycystic Kidney Disease, etc. We can also test for chromosome rearrangements like translocations or testing embryos for genetic ‘normality’ (sometimes called Comprehensive Chromosome Screening or CCS). PGD can be performed for family balancing for couples who have at least one child and desire a child of the opposite gender. PGD cannot be used to select height or any other physical characteristic or intelligence and should not be used to select eye color or other appearance traits.

Is IVF the only option for couples who cannot conceive on their own?

Most couples who are trying to conceive without success don’t need IVF or ICSI – If cheaper and easier treatment is appropriate we try other things first. Sometimes IVF is the right answer: if inseminations aren’t working for severe disease of the fallopian tubes or diminished ovarian reserve (low egg supply) or for severe sperm problems needing ICSI. See a Reproductive Endocrinology and Infertility (REI) specialist for testing and for treatment options.

What is Embryo transfer?

The embryo transfer is the last step in the IVF process. It is a crucial phase of the treatment, which can take place on the third day of embryonic development or on the fifth or sixth day if the transfer is performed at blastocyst stage.

What does it consist in?

It is usually a simple process that is carried out next to the IVF laboratory. Before the transfer, your gynecologist will perform an abdominal ultrasound to assess the position of the uterus and the state of the endometrium, followed by a careful cervical cleaning. For the embryo transfer, a very fine catheter made of a very flexible material is used, to not damage the walls of the endometrium.

After the transfer, It is recommended that you remain at rest for a few minutes, being able to resume daily activities without problem and with minimal restrictions.

Is embryo transfer dangerous or painful?

No, It is not. It is a very safe and painless procedure that does not require sedation and carries the same minimal discomfort as when the gynecologist performs a vaginal cytology.

How should I prepare myself for the embryo transfer?

No special preparation is needed before the embryo transfer. The most essential thing is that you drink water and do not urinate before the transfer: that way, the bladder will be full and will help to visualize better the uterus and favor the canalization of the cervix with the catheter. Also, remember to go to the clinic around 30 minutes in advance so that you can talk calmly with your doctors and biologists about the process!

If you get your tubes tied, could you still have a baby with help from IVF?

Absolutely, having blocked tubes is the reason IVF was invented. IVF is often a better approach than a surgical tubal ligation reversal. See a specialist (Reproductive Endocrinology and Infertility or REI MD) who offers both options to assess your individual situation. A basic workup includes checking your partner’s sperm (Semen Analysis) even if he’s the father of your kids and checking your egg supply or ovarian reserve.

How many IVF treatments does it take to become pregnant?

Typically, one to three fresh IVF cycles, but your age and ovarian reserve (egg supply) are obviously major factors. In general, the best results with IVF are up to age 40. Success rates drop each year after 40 and are very low by age 45, using your own eggs. If you have embryos to freeze with a fresh IVF cycle, It can increase your chances of success and lower the number of fresh cycles that you need. Egg donation has high success rates at any age.

Will preparing for an IVF cycle be painful?

In Vitro Fertilisation or IVF involves around 8-12 days of fertility injections. Typically, there is some discomfort from the shots, which usually go in under the skin in your stomach area, similar to diabetics taking insulin shots. During this time your ovaries get bigger, and you may feel bloated or uncomfortable – most women don’t feel like jogging or heavy exercise at this time. You should be asleep, or very deeply sedated, during the egg retrieval procedure itself, where eggs are removed from your ovaries under ultrasound guidance by placing a needle through the vaginal wall. After this procedure your ovaries may be sore for a day or two and you may take some pain medicine.

Before embryos are put back into your uterus, usually 3 to 5 days after the egg retrieval, some clinics put you in intramuscular progesterone shots, which are shots that go in your buttocks – most women have their husband or partner give these shots, which can be mildly painful. Other clinics use vaginal progesterone instead which is a more comfortable option. Putting embryos back inside your uterus, or embryo transfer, is painless but you have a medium full bladder, and many clinics give you something to help you relax for this procedure.

So, not very painful but some discomfort and mild pain is possible. Talk to your fertility clinic about your concerns, too.

How long do I have to use the drugs?

The duration of your injections will be determined by the in-vitro fertilisation (IVF) regimen chosen for you at our Cyprus IVF clinic. Injections are usually given for 8 to 12 days; however, some patients may need them for a little longer.

Can I take my trigger shot (ovidrel/lupron) a few hours later?

NO! The only drug that is time-sensitive is the “trigger” shot given before egg retrieval. Setting a reminder for yourself to take at the exact time you are told is recommended. Please inform your coordinator or your nurse if you take your trigger shot at a different time than recommended, as your egg retrieval time may need to be changed.

I had one embryo transferred: why am i pregnant with twins?

As with natural conceptions, an IVF-derived embryo can split during early development (after embryo transfer) and result in an identical twin pregnancy.

The other possibility is if you have unprotected sex around the time of your embryo transfer and have a concurrent natural conception. This is why we recommend abstaining or using condoms while undergoing an IVF/embryo transfer cycle. Our goal is always ONE healthy baby at a time!

Can I expect any side effects during treatment?

When the ovaries are overstimulated by fertility medicine used in IVF or other fertility therapies, ovarian hyper-stimulation syndrome, or OHSS, can occur. OHSS symptoms are often mild to moderate, with mild to moderate pain, loss of appetite, nausea, diarrhoea, bloating, breast tenderness, and a mild emotional response. If you experience any of the symptoms listed above after receiving a hormone injection, you should contact our Cyprus IVF hospital for assistance and monitoring.

Is it okay if I take my stimulation medications (Gonal-F/ Menopur) a few hours late?

Yes, however, It’s better if you take your medications at the same time every day.

Why do i have to do progesterone in oil injections?

Your doctor will decide on the best route for you to take progesterone. Sometimes it’s taken vaginally, sometimes intramuscularly, and sometimes both.

Why do i need to take progesterone and estrogen after my embryo transfer?

For frozen embryo transfers (depending on the type of cycle your physician prescribes), the lining of the uterus is sometimes prepared with estrogen followed by the addition of progesterone. For fresh IVF cycles, progesterone alone is usually sufficient.

After injecting cetrotide, I have a rash or reaction. What should I do?

Cetrotide can irritate the skin, and you may see redness at the injection site; this is normal and does not indicate an allergic reaction. Ice can be applied to the injection site to ease the pain and redness. Within 24 hours, it should be gone. If you experience breathing problems or other serious signs or symptoms of a severe allergic response (which is extremely rare), get to the nearest emergency hospital right away.

Can someone over the age of 45 undergo IVF?

Yes, It’s possible, but the chances of success are low if we use the woman’s own eggs. At age 45 the pregnancy rate with IVF treatment is around 1 in 100 or 1%, and miscarriages are more common in this age group, so the live birth rate is less than 1%.

A woman over 45 is much better off with IVF using an egg donor. Pregnancy and live birth rates vary from clinic to clinic, and with using fresh donor eggs or frozen donor eggs. In our practice we aim for at least a 75% success rate with fresh donor eggs, and we have been into the 80’s success rate for the last three years.

You should also check with your own clinic, as some have age cutoffs for IVF with your own eggs, such as not allowing IVF with your own eggs over age 43, or over age 45.

Am I at risk of getting pregnant with twins if I go through IVF?

There is always a chance of twins with any pregnancy, but most of our IVF pregnancies are a single baby. The risk of twins is affected by how many embryos are transferred into your uterus, your age, the stage of the embryos (day 5 or 6 blastocyst-stage embryos are more likely to implant than day 2 or 3 cleavage-stage embryos), and the quality of the embryos. If you are under 35 with high quality embryos, there is about a 40% chance of twins if two embryos are transferred, and less than a 5% chance of twins with one embryo transferred – a single embryo can split into identical twins. Blastocysts are more likely to split.

Identical twins from IVF is a rare event. Most twins from IVF are non-identical, from two different embryos. Here at Overlake Reproductive Health, we only implant one healthy embryo at a time limiting the risk of multiples. Not all pregnancies that start as twins end as twins – some twin pregnancies result in miscarriage of one twin and survival of the other one so that you end up with a single baby.

Single Embryo Transfer (SET) is preferable because one baby at a time is safer for all involved. Other IVF clinics implant multiple embryos at a time to increase their IVF success rates. We use PGT to genetically test each embryo before we insert it which limits the chance of early miscarriage. So even though we insert one embryo per cycle, our success rates are among the highest in the country. Plus, because our embryos are frozen, if one cycle does not result in a pregnancy, you can insert a second embryo in a following month.

Talk to your MD about your concerns regarding twins and together you can decide the right number of embryos to transfer. They can give you specific guidance as they know your individual situation. We put our patient’s health first so the risk of twins with our IVF process is extremely low.

Can egg vitrification cause problems during the pregnancy?

From the moment the embryos are implanted in the uterus, the pregnancy is the same as any other. The data collected on the pregnancies and children born after frozen embryo treatments have not shown any difference with regard to embryos transferred without previous cryopreservation. Therefore, the scientific evidence is completely reassuring.

How many eggs are frozen during treatment?

The eggs are not extracted and frozen individually but rather in groups. Usually with each menstrual cycle, our body uses between 20 and 50 eggs for ovulation, depending on the woman. Of these, usually only one egg ovulates naturally, which is the one which reaches the best maturity. In order to undergo vitrification, hormone stimulation is performed to try to recover all these eggs and to try to collect around 15 or 20 to freeze.

Why is IVF an expensive procedure?

This method requires a highly trained staff and the latest technology in equipment. The equipment and materials used in an IVF lab are all imported and costly. Also, most of the materials used are disposable and in single-use format. Further, most medication and injections in the pre-natal stage are imported and are expensive. Cost of medicines and medical consumables is about 50% of the total cost.

What happens during egg retrieval, and how long does it take?

An ultrasound probe and a long needle with a suction device are used to retrieve your eggs transvaginally. You will be sedated and given pain medication throughout the egg retrieval procedure. This treatment takes about 30 minutes on average. It would help if you assumed that the preparations, process and recovery time would take roughly 2 hours total.

Do I need an empty bladder for egg pick up (vagina ultrasound)?

Yes, Vaginal ultrasounds for egg retrieval necessitate an empty bladder.

Is egg retrieval a painful procedure?

The procedure is not painful but can cause mild discomfort. At our clinic, we use mild anaesthesia administered through an IV line which relieves the pain. A patient rarely will need a heavy dose of anaesthetic drugs.

How will I feel after the egg collection procedure?

Drowsiness is the most commonly seen side effect of anaesthesia. Patients report aches in the groin area near the bladder. Because the ovaries are enlarged, patients usually feel this ache before the egg collection procedure.

What kind of activity restrictions do I have while I'm undergoing treatment?

During treatment, always follow your health provider’s activity limits. As a general guideline, you should limit your physical activity during the stimulation phase of your egg retrieval cycle to walking, swimming, or other low-impact exercises. Yoga and any other exercise that requires jumping and twisting at the waist, as well as other jarring motions, should be avoided. During this stage of treatment, your ovaries may swell and feel heavy, and there is a slight possibility of ovarian twisting or “torsion.” Torsion patients experience extreme pain and nausea and may require surgical intervention.

Do all eggs get fertilised?

The average fertilisation rate is 65%; while some couples have a higher fertilisation rate, total fertilisation failure occurs.

Is a full bladder considered necessary for embryo transfer?

Yes. We use ultrasound to view your uterus and check embryo placement throughout this procedure. A full bladder allows for a more precise scan and makes embryo delivery easier in the uterus.

How long does the transfer of embryos take?

The embryo transfer occurs in our procedure room and consists of a simple procedure (similar to a smear test) to return the embryo to your uterus. It will take about 15 to 20 minutes to complete the operation. In most cases, there is no discomfort or pain associated with this operation.

Can I go to the toilet after my embryo transfer?

Yes, you can because the uterus is a strong muscle that protects the embryo or fetus during pregnancy. Furthermore, a thick gel maintains the implanting embryo inside the uterus, where the embryo/fetus connects. As a result, you won’t be able to urinate or poop out the embryo.

How soon after embryo transfer can we have sexual intercourse?

You can have sexual intercourse two days after the embryo transfer. Some people recommend more extended periods of sexual abstinence, but studies show that intercourse on the transfer day does not affect the pregnancy rate.

How long should I rest after the embryo transfer procedure?

Resting fifteen or twenty minutes after the transfer is usually sufficient. We do not recommend heavy exercise and walking for long distances. Women who work at a desk can perform the next day resume daily activities. Sexual intercourse is allowed two days after the transfer. Although there is no scientific proof in this area, we recommend that women refrain from challenging exercise or beginning a new sport.

When can I bathe after the embryo transfer?

You can bathe a few hours after the procedure. We do not recommend extreme heat as is found in Turkish baths, saunas or solariums. Also, we recommend that you refrain from physical therapy using ultrasound for a few days after the procedure. There is no scientific proof backing this restriction.

Why don't some embryos implant even if they are of good quality?

A good quality embryo has a higher potential to be genetically normal, but the perceived quality is not the absolute criteria. Other unknown factors are influencing the pregnancy rate, such as endometrial receptivity.

Infertility treatments: what to expect or not to expect in the 2 ww (Waiting Weeks).

The best advice that a patient can be given is to take things easy during these weeks, though they can lead normal life. Rest as much as you can, relieve your stress by pursuing your habits like reading, sketching, watching shows and socializing. Do not indulge in heavy work or lifting things. Avoid travel. Eat healthy food and stay healthy mentally and physically.

How do you calculate the date of delivery after an IVF procedure?

Many pregnant women following a fertility treatment wonder how the calculations are made both the pregnancy weeks and their due date, since it is something different to a natural pregnancy.

In a pregnancy using IVF, the moment of implantation is taken into account, since fertilisation took place in the laboratory some 48 hours before. Therefore, it does not follow the natural course of a fertilised egg, which takes about 7 days to implant in the uterus. The correct thing to take into consideration is to count from the day of implantation and to calculate the probable date of birth, which is done by adding 270 days to that date instead of the usual 280 days or 38 weeks.

It is important to remember that the delivery date is an estimate. Only a very small percentage of women give birth on the day of delivery estimated by the doctor.